The part of Obamacare that Congress must keep

Cost-sharing reductions keep care in reach for low-income Texans

Cost-sharing reductions have helped more than 200,000 in the greater Houston area alone afford doctor visit copayments, X-rays and other services. In this photo: U.S. Speaker of the House Paul Ryan.

Photo: Win McNamee, Staff

Chaotic attempts to "repeal and replace" or simply destroy the Affordable Care Act (ACA) continue: the House GOP are devising new ACA repeal alternatives; President Trump says he could refuse to pay Cost-Sharing Reductions (CSRs) to insurance companies; and a new amendment to the previously rejected AHCA bill contravenes the ban on preexisting conditions and has led the American Association of Retired Persons (AARP) to warn that 25 million Americans between 50-64 could lose health coverage under the so-called MacArthur Amendment alone.

Our members of Congress should reject these blatant attempts to hold the health insurance of millions of Americans hostage. And they should include the CSRs that help our low-income neighbors afford care. Breaking news reports that CSRs will be continued "for now" do little to help long term. Temporary assurances are not enough; we need a firm funding commitment for the rest of 2017, 2018 and until we have negotiated a permanent solution.

Contrary to irresponsible rumors, the ACA is stable, and more insurers are planning to reenter in 2018. If CSRs are withheld, though, millions more who buy insurance through the Marketplace are at risk of losing their access to care. CSRs have helped more than 200,000 in the greater Houston area alone afford doctor visit copayments, X-rays and other services. In fact, CSRs are one of the last things anyone should remove from the ACA, since a great thing about them is the "sharing."

As CEO of Community Health Choice, a nonprofit health insurer, I believe our system is stronger when we all make investments in our own lives. CSRs help us offer lower priced health insurance to qualifying individuals and families. In 2016, we were able to provide $50 million worth of savings to our Marketplace Members. CSRs are crucial to the stability of insurers like us operating under the ACA.

What does cost-sharing mean in real terms? Consider this hardworking young Texas family with a preschool daughter: Dad is a diner cook, Mom is a child care assistant. Their combined earnings are $30,000 a year. After making payments for housing, their car, groceries, utilities, there isn't much left, but some of what's saved can go for important expenses like health insurance. Most restaurant and child care workers don't have employer-sponsored coverage, but here's good news: During ACA open enrollment, this family would have been able to purchase a Community Health Choice "Silver" plan with Advanced Premium Tax Credits (APTC) and CSRs. Their monthly premium would have averaged $60; taking their daughter to the doctor would have cost only $10 out of pocket.

In this scenario, the family is still contributing — they pay the monthly premiums and meet the deductibles and copayments — but the ACA and CSRs have helped make both their coverage and care truly affordable.

Simply, CSRs are federal tax dollars that have come home to help Texans and reimburse health insurers for having initially covered the difference for lower deductibles and copayments. Working adults and families making between $12,000 and $30,000 a year who purchase Silver plans qualify for lower deductibles and copayments (thanks to cost-sharing reductions) so they do not have to skip care.

In 2016 alone, we used CSRs to help 55,000 people making between $12,000 and $30,000 afford access to high-quality health care at providers like UT Physicians, Baylor College of Medicine, Memorial Hermann, Kelsey Seybold, and St. Luke's Hospital.

Without CSRs, our formerly eligible members would have paid 20 percent or more for their health insurance. For that Texas family I described – and many like them – CSRs make the difference in whether they can afford to visit the doctor at all.

A study by the Association for Community Affiliated Plans (ACAP) and the research group Milliman pegged CSRs nationally at about $4.9 billion in 2015, or roughly 8 percent of earned Marketplace premium for all insurers. In Texas in 2015, CSRs contributed more than $46 million for health insurers to help offset costs for more than 140,700 Texans.

If Congress leaves CSRs unfunded, health plans in the Marketplaces will be hurt, and many will leave the Marketplace. My organization wants to fulfill our mission and continue to open doors of access to high-quality health care in 2018. However, mixed signals from — and between — Congress and the Trump Administration make it impossible to know how to plan for next year. If CSRs are unfunded, insurers will be forced to raise prices for all 150,000 people covered in the Marketplace by 20 percent or more to cover the loss of funds the ACA clearly intended to be paid by the federal government. And few health plans would be able to sustain unplanned expenses of such a magnitude.

Fortunately, the Texas Congressional delegation can act to foster a more stable business environment for health plans by appropriating CSR funds as part of the Continuing Resolution to prevent the government from shutting down. My organization joins the U.S. Chamber of Commerce, Republican and former Senate Majority Leader Bill Frist, M.D. and leaders across the nation in calling to extend CSRs.

Congress: The next steps are yours. Help keep us working for Texans.

First: Drop the destructive "repeal" machinations that would penalize people with preexisting conditions and hurt older and more vulnerable Americans, and let us work with you on the real ACA reforms needed.

Second: Appropriate CSR funding into a Continuing Resolution and pass it; when President Trump signs it, the doors of access to health care will stay open for hard-working Texans.

Ken Janda (@HealthyTexans) is president and CEO of Community Health Choice, a nonprofit insurer covering the health of nearly half a million Houstonians. He is an adjunct professor at Rice University's Jones School of Business and an active board member for community and philanthropic organizations.